The United Nations has expressed alarm over spiraling violence in Syria as opposition groups continue to battle pro-government forces in the central province of Hama, and fighters from a US-backed, Kurdish-led coalition battle government forces in the country’s northeast.

State news agency SANA said Syrian troops were fighting fierce battles in the central Hama province on Tuesday. Syrian and Russian warplanes carried out air attacks in the northern Hama countryside, according to state media.

The opposition groups’ military operations administration said they captured 14 central villages and towns including Halfaya, Taybat al-Imam, Maardis and Suran. The UK-based Syrian Observatory for Human Rights, an opposition war monitor, confirmed that the four towns were taken.

After their rapid takeover of the city of Aleppo last week, the rebel groups led by Hayat Tahrir al-Sham (HTS), as well as Turkiye-backed opposition fighters, are pressing south towards Hama city, the country’s fourth-largest.

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Last week’s assault by forces opposed to Syrian President Bashar al-Assad is the biggest offensive for years in a conflict which began in 2011 and whose front lines had been frozen since 2020.

Civilian casualties

UN Secretary-General Antonio Guterres said he was “alarmed” by the escalation in violence and called for an immediate halt to the fighting.

The UN human rights office warned that the spiralling violence was deepening the suffering endured by millions.

“Our office has documented a number of extremely concerning incidents resulting in multiple civilian casualties, including a high number of women and children, stemming from attacks by both Hayat Tahrir al-Sham (HTS) and by pro-government forces,” said a spokesman for UN High Commissioner for Human Rights Volker Turk.

The hostilities are also damaging health facilities, education buildings, and food markets, he added.

Al Jazeera’s fact-checking agency Sanad mapped sites in Aleppo and Idlib hit by Russian and Syrian warplanes in the operation against the opposition.

These sites include medical facilities, camps housing displaced people, popular markets, schools and mosques.

Meanwhile, the number of casualties from attacks by pro-government forces in Idlib from November 27 to December 2 has risen to 81 civilians, including 34 children and 12 women, according to the Syrian Civil Defence.

Another 304 people have been wounded, including 120 children and 78 women, it said.

The World Health Organization also warned that the healthcare system in Aleppo was “under immense strain”.

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“Referral hospitals are overwhelmed with trauma cases, with thousands of injuries admitted in the last four days alone and doctors and nurses working around the clock to save lives, even at great personal risk to themselves and their families,” WHO’s acting representative in Syria Christina Bethke told reporters by video from Damascus.

She said that prior to the escalation, there had been 42 functioning or partially functioning hospitals in Aleppo – but not fewer than eight “continue to operate at minimal capacity”.

In what appeared to suggest the opening of a new front for al-Assad in northeastern Syria, fighters from the Syrian Democratic Forces (SDF), an umbrella group that controls territory in Syria’s east with US support, battled with government troops near several villages across the Euphrates River from regional capital Deir Az Zor on Tuesday, both sides said.

The SDF said early on Tuesday that its Deir Az Zor Military Council had “become responsible for protecting” seven villages previously held by the Syrian army.

The Deir al-Zor Military Council comprises local Arab fighters under the SDF, an alliance mainly led by a Kurdish fighter group, the People’s Protection Units (YPG).

Syrian state media reported that the army and allied forces were repelling an SDF assault on the villages, the only Syrian government presence along the east bank of the Euphrates River, an area otherwise mostly held by the SDF.

The latest surge in fighting marks the most significant turn in years in Syria’s war, which began after a brutal crackdown on a popular uprising in 2011.

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The violence has forced 50,000 people to flee their homes in recent days, the UN said on Monday.